Known injury issues for the 'current' forehand?

Discussion in 'Health & Fitness' started by Chas Tennis, Apr 30, 2012.

  1. Chas Tennis

    Chas Tennis Hall of Fame

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    I started working on my forehand with a ball machine. The high speed videos do not look good especially since I am trying to do the 'current' forehand, new to me. The strokes do not look very consistent from one shot to the next.....I have a list of errors after just one video.

    By 'current' forehand I mean the semi-Western grip(probably), the unit turn, 'pat the dog on the head', 'turn the door knob', etc., as best described by Rick Macci in On Court with USPTA and in this month's May '12 issue of Tennis magazine.

    For stroke description see this video and others in the xstf forehand series.
    http://www.youtube.com/watch?v=_Oc7U5oJ6ps&feature=fvwrel

    I started getting a little wrist pain on the little finger side that I believe is due to some occasional poor FH stroke motion. I can also feel the pain if I practice swings with just the racket and no ball impacts. First, I'd like to identify and avoid whatever is stressing my wrist. Any thoughts?

    Next, I would like to know ahead of time other known injuries that are associated with the 'current' forehand. What are they?
     
    Last edited: Apr 30, 2012
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  2. t135

    t135 Semi-Pro

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    This current thing you speak of has been around for maybe 25 years or so. Mainstream for maybe 20?
     
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  3. r2473

    r2473 Legend

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    Post this in "Tips" section with a video of YOU swinging. If you do it "right", I don't think there are any "known injuries".

    Look, if there were "known" injuries, Rafa would be getting hurt on a daily basis (and I don't mean his knees).
     
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  4. Chas Tennis

    Chas Tennis Hall of Fame

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    I agree that if it is done correctly that there would be few injuries. I'm worried mostly about identifying common poor technique errors.

    1) TE occurs on the 1HBH most often probably from using poor technique. Are there similar issues for this forehand?

    2) I briefly met someone who was getting golfer's elbow from his forehand. I could look at his stroke and see an excessive internal shoulder rotation with his shoulder mostly adducted and his elbow around 90 d.. I had given myself an instant GE injury using a very similar poor technique on the volley.
     
    Last edited: May 1, 2012
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  5. Chas Tennis

    Chas Tennis Hall of Fame

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    Macci, page 34 in May 2012 Tennis magazine says that the speed of the pro game has changed "dramatically in the last five years. Balls arrive more quickly................And on the forehand, the preparation has changed in a major way,.........."

    You may be right in that some elements have been around since the early 1990's but maybe they are now more exaggerated.

    Maybe the descriptions are becoming much better also. The Macci descriptions are excellent although still lacking in any identification of the muscles. He has also mentioned motion capture research with Brian Gordon to break down the stroke.

    As of a few years ago none of this stuff had found its way into my lessons.

    Too high level for me? I am sold because the other night I warmed up using a 'unit turn' with hand on racket, etc., as described and was immediately hitting some better pace. It felt better.
     
    Last edited: May 1, 2012
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  6. r2473

    r2473 Legend

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    In a "proper" kinetic chain swing, big muscles move the small muscles.

    If you are repetitively using your small muscles to create the swing, you will probably develop a common repetitive use injury (tennis elbow, golf elbow, etc).

    Ask yourself "Am I pulling or pushing when I swing?". If you are pulling, (hips and torso move the shoulder which moves the arm), you are probably going to be fine. If you are pushing (your arm is creating most of the power in your swing), you will probably get into trouble.

    It's the same on the serve. If your hip and torso rotation are creating your power, you should get near effortless and pain free power. If you are using your shoulder and arm to create power, its probably only a matter of time before you develop an injury.

    I'm sure you know all this stuff, but I think it really is as simple as that.

    I think Pat Dougherty explains all this best in the Bollettieri videos:

    http://www.amazon.com/gp/product/B0..._m=ATVPDKIKX0DER&pf_rd_r=0NV8EN2F5SAANP9W3TFN

    http://www.amazon.com/Nick-Bollettieris-Stroke-Instruction-Series/dp/B0019KDUPW
     
    Last edited: May 1, 2012
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  7. El Diablo

    El Diablo Hall of Fame

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    Nearly all violent motions of the wrist increase the risk of carpal tunnel syndrome.
     
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  8. r2473

    r2473 Legend

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    I don't know. I think it depends more on if it just happens "naturally" as a result of the kinetic chain, or if you are really just moving your wrist.

    If you look at any good server, the wrist pronates a lot. The racquet head is usually pointing straight down toward the court before it goes past the waist. But, I don't think this is at all stressful. It just happens naturally.

    [​IMG]
     
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  9. Chas Tennis

    Chas Tennis Hall of Fame

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    My golfer's elbow injury occurred during a single volley when I tried to use my large internal shoulder rotators, mainly the lat I believe, to rapidly rotate my upper arm while my racket and forearm were at right angles. Ping! Ouch! the elbow hurt instantly at the inside of the elbow. The forearm muscle-tendon was already stretched and then, because of the inertia mass of the bent forearm with racket, was very forcefully stretched farther when the lat fired. Some area of the tendon was torn. That is the kind of very dangerous poor technique I'm concerned about.

    Your push-pull description is very interesting.

    The second video, SONIC SERVE, is the best made instructional video that I have seen with many good points. Unfortunately, made in 2000, I don't believe that it mentions internal shoulder rotation as the main contributor to racket head speed. The servers had been doing it of course. Therefore, Sonic Serve is outdated. After viewing it I tried to learn some more forceful trunk rotation/motion and I threw out my back. I believe the video is very good and that my brief back injury was my misinterpretation or accidental poor technique. This is another example of why I'm very concerned about accidental poor technique especially when learning a new stroke.
     
    Last edited: May 1, 2012
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  10. r2473

    r2473 Legend

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    ^^ I agree. It's not easy to do and the risk of injury is real.

    Your golfers elbow sounds like a "one-off".

    Your back injury is either the result of something not quite right with your techinque or it could be that something in your back simply wasn't strong enough to handle the torque from this type of service motion. As a result, you either simply injured something in a straight forward manner, or because something wasn't strong enough, you made "unreflective" compensations / alterations, and that resulted in injury.

    I tell people that don't play tennis all the time that it is a "brutal" sport. Everyone laughs at me.

    By the way, what do you mean by "internal shoulder rotation"? I'm not sure I'm following.
     
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  11. charliefedererer

    charliefedererer Legend

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    It's too bad, although interesting, that 4 of the threads from today/yesterday involve wrist injuries.


    As r2473 said, "If you are repetitively using your small muscles to create the swing, you will probably develop a common repetitive use injury (tennis elbow, golf elbow, etc). "


    But even if done correctly, any new motion may put added stress on an area not prepared to handle it.


    Had you been doing the thrower's ten exercises? http://www.muhlenberg.edu/pdf/main/athletics/athletic_training/throwers10.pdf

    What type of string/racquet are you using?

    Did you see my post yesterday to sportsfan1? http://tt.tennis-warehouse.com/showthread.php?t=422283 I think it relates to you as well:


    "The rest and ice is a great idea to start.

    As is the decision to see a specialist.

    A hand specialist/hand surgeon takes care of problems of the hand and wrist. This likely will be an orthopod who received extra training, and now limits his practice soley to diseases of the hand and wrist. There very likely is someone in your area who sees a lot of sports injuries - you may see information to this effect on his web site.

    It is possible you have a problem with the TFCC

    [​IMG]

    You may want to read the section on wrist injuries from the USTA. The following is one selection, but there are several cases discussed there:

    "The problem sounds pretty familiar and the injury may involve the Triangular Fibro-Cartilage Complex (TFCC) in the wrist – which functions much like the meniscus in the knee. However, this injury is impossible to diagnose over the Internet and the player would need to have the x-rays examined by a doctor who has experience with TFCC injuries, and has experience with tennis players, to get an accurate diagnosis. Unfortunately, I have found that not a lot of doctors really know what TFCC injuries in tennis players look like.

    The classical treatments for a TFCC injury include change in grip - not necessarily a racquet change (e.g. use less of a Western grip on the forehand, less cocking on the two-handed backhand), taping the wrist, strengthening not only the wrist but the forearm and shoulder muscles, and making sure the player uses the entire kinetic chain, not just the arm when hitting.

    Surgical treatment may be necessary if symptoms persist. The problem is often not in the actual TFCC, but in the attachments around the edges of the TFCC. When these attachments are damaged, the TFCC slides into the joint between the bones, and can give pain, swelling, and clicking."
    - http://www.usta.com/Improve-Your-Ga...uries-Prevention-and-Recovery/Wrist_Injuries/

    A hand specialist/hand surgeon takes care of problems of the hand and wrist. This likely will be an orthopod who received extra training, and now limits his practice soley to diseases of the hand and wrist. There very likely is someone in your area who sees a lot of sports injuries - you may see information to this effect on his web site."
     
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  12. Chas Tennis

    Chas Tennis Hall of Fame

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    LOL, you have come to the right place.

    Over the last 20 years ISR was identified by biomechanical researchers using high speed imaging as the largest contributor to racket head speed on the serve.

    Read this long thread and look particularly at Toly's illustrations and discussions.

    http://tt.tennis-warehouse.com/showthread.php?t=370729

    The thread was a revelation to me. Basically, the term 'Pronation' is very often used incorrectly for the serving motion but the racket head speed comes mainly from upper arm internal shoulder rotation with forearm pronation contributing much less. Search the terms for proper definitions.

    Biomechanics and Tennis, B. Elliott, published on ISR & serve.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2577481/
     
    Last edited: May 1, 2012
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  13. charliefedererer

    charliefedererer Legend

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    From:

    Br J Sports Med. 2006 May; 40(5): 392–396.
    doi: 10.1136/bjsm.2005.023150 PMCID: PMC2577481

    Copyright ©2006 British Journal of Sports Medicine.
    Biomechanics and tennis
    B Elliott
    Correspondence to: Professor Elliott
    University of Western Australia, Perth, WA, Australia; bruce.elliott@uwa.edu.au

    "Internal rotation of the upper arm at the shoulder

    Work by my team has primarily been responsible for identifying the important role that internal rotation of the upper arm at the shoulder joint plays in the service (fig 2​2)) and the forehand strokes (table 2​2).10,14 This factor has in many ways modified the way that these strokes are developed at beginner and advanced levels of play. The images in fig 2​2 show how internal rotation at the shoulder, which begins before impact, continues into the early follow through phase of the service action. Functionally, the internal rotator musculature must accelerate the upper arm in the swing to impact, before the external rotators eccentrically contract to decelerate this rotation during the follow through phase of the action. As the external rotators are much smaller than their internal rotator counterparts, it is essential that specific training is structured to protect the shoulder from injury, as discussed in the sports medicine section below."


    There's a lot of information in this brief article.
     
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  14. Chas Tennis

    Chas Tennis Hall of Fame

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    I do not think that my wrist is injured yet but that I'm pinching something with some new technique and can feel it.

    In particular, I was practicing taking FH swings inside with no ball impacts. I could feel it more there than when hitting balls. Was there more racket head speed?..........

    My high speed videos with the ball machine were very inconsistent with regard to wrist position. The wrist is not relaxed but trying to hold some ill- conceived positions, also varying for different hits.

    The wrist injury that you illustrate is at the location of the pain. Spot on information to look into especially the semi-Western grip. Thanks.

    One possibility - Joints reach the end of their range of motion when ligaments tighten or things just get squished. If you accelerate a racket or hit a ball when the wrist is near the end of its ROM there is probably going to be trouble.
     
    Last edited: May 25, 2012
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  15. r2473

    r2473 Legend

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    Seems to me that "internal shoulder rotation" is part of the kinetic chain, but certainly not the first part.

    I think if you have good hip/trunk/torso rotation, the internal shoulder rotation should "just happen" as part of a normal, relaxed kinetic chain motion.

    I'll be honest. I couldn't follow what Toly was saying in some of the threads you linked to.

    I certainly agree with Charlie's about strengthening your shoulder to avoid injury:


    "Functionally, the internal rotator musculature must accelerate the upper arm in the swing to impact, before the external rotators eccentrically contract to decelerate this rotation during the follow through phase of the action. As the external rotators are much smaller than their internal rotator counterparts, it is essential that specific training is structured to protect the shoulder from injury"

    But I have to say that I don't really feel that my external rotators eccentrically contract to decelerate this rotation during the follow through phase of the action. I feel like the swing ends "naturally". I don't feel like I need to try to stop it. On the contrary. Trying to stop it is how you get hurt. Just start the swing with your hip/torso rotation and "let it fly".

    Anyway, doing any of this is like throwing a baseball to me. So it makes sense to do the "Throwers 10" (or something similar). I just realized the other day that I do most if not all of the throwers 10 as part of some of my normal "workouts" and have been doing it for many years.
     
    Last edited: May 1, 2012
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  16. charliefedererer

    charliefedererer Legend

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    But also building up the elastic "resisting" muscles should mean that less force ultimately will be transferred to non-elastic ligaments at the joint.

    In addition to the thrower's ten exercies, use of the Theraband Flexbar or use of a hand gripper (even squeezing a tennis ball) can help build up the forearm muscles that control the wrist.
     
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  17. charliefedererer

    charliefedererer Legend

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    I don't think we are conscious that the external rotators are contracting to stop the arm. But they probably are contracting anyway, and help prevent the force from being transmitted to the ligaments of the shoulder.

    In particular, the rotator cuff muslces, though small, are important "stabilizers" of the shoulder joint. As "stabilizers", they are not really big movers or stoppers of the motion of the joint, but help to maintain proper positioning of the head of the humerus and keep it from sliding out of the very shallow glenoid fossa. Interestingly as small as these muscles are, they are important not only for tennis, but actually are necessary for a strong bench press!

    "If you have the rotator cuff strength of a little girl, your body has no choice but to limit the amount of weight you can stabilize and move to prevent injury. It's not uncommon to see an individual break through a bench press sticking point simply by incorporating direct rotator cuff training.
    OK maybe now I have your attention. So how do you make sure your rotator cuff isn't the weak link in your bench press? Or even more importantly how will you prevent a bench press blowout where you damage the rotator cuff?Like we discussed you need to strengthen the muscles, so let's take a look at this workout routine. Remember if you already have an injury you should not use this routine as a rehab program but rather visit a sports medicine physician. If you want to prevent a future injury and break past a bench press sticking point then follow this routine twice a week."
    - Mike Westerdal http://www.bodybuilding.com/fun/criticalbench24.htm


    I think that perhaps a bigger problem with those not exercising is that the muscles stabilizing the scapulae are not contracting enough, allowing the shoulder to "move forward" too much, straining the ligaments and the rotator cuff muscles (particularly the supraspinatus).

    "The scapula serves as the base or platform for the rotator cuff. A properly stabilized scapula allows for optimal rotator cuff activation. A recent study found that rotator cuff strength increased as much as 24% when the scapula was stabilized and retracted45. For this reason, recovery should focus on scapular strengthening ratherthan placing an early emphasis on rotator cuff strengthening. Once the scapula is
    properly stabilized, more advanced exercises can be incorporated to strengthen the larger global muscles around the shoulder as well as the rotator cuff."
    - p. 142 of the USTA's Tennis Recovery: A Comprehensive Review of the Research http://assets.usta.com/assets/1/dps/usta_master/sitecore_usta/RECOVERY PROJECT FINAL.pdf

    [​IMG]

    Great to hear you have been doing the Thrower's 10. :)
     
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  18. r2473

    r2473 Legend

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    I'll say that, since I have been doing "advanced" bodyweight exercises, I've noticed a substantial increase in my (oh man I hate to say this) "functional strength" as compared to when I was doing traditional barbell / dumbbell exercises. Different sort of strength anyway that translates well into what you are talking about above. Holding yourself in a straight-arm hold does miracles to really strengthen your complete shoulder.

    [​IMG]

    That's not to say that overhead pressing isn't important. It is. They are both important in different ways.
     
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  19. charliefedererer

    charliefedererer Legend

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    I've always been in awe of gymnasts.

    Floor exercise, pommel horse, still rings, vault, parallel bars, and high bar.

    How do they do it?
     
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  20. Chas Tennis

    Chas Tennis Hall of Fame

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    What is a "one-off" injury?
     
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  21. tricky

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    As you swing through contact point, do you feel that the pronation is led by the thumb or pinkie side of the forearm?
     
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  22. Chas Tennis

    Chas Tennis Hall of Fame

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    I have not thought about it, I'll see how it feels. I'll look over my videos but they are inconsistent hit to hit.

    When I watch high speed videos of pros what I think I see is internal shoulder rotation and pronation starting just prior to impact and continuing, the 'turn the door knob' rotation. The amount of this rotation that has occurred by impact is very small and most rotation occurs after impact. I believe that the main purpose is to add topspin and am very unclear on the pace/power contribution.

    [The two older players in my league match tonight each had wrist straps........]
     
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  23. Chas Tennis

    Chas Tennis Hall of Fame

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    ISR on the serve

    ISR is the last part of the kinetic chain, the part that directly applies turning force to the wrist and provides most of the final power transfer to the racket handle for the serve.

    One confusing point is that I can easily think of at least three motions that are going on in the serve and might logically be called 'shoulder rotation':

    1) the shoulders rotate around a vertical axis with body/trunk turn. This rotation itself surprisingly subtracts from racket head speed but it may load/stretch muscles that increase racket head speed. This rotation is in the opposite direction to that of ISR. Very visible to eye.
    2) the shoulders rotate up-down, hitting arm low to high. Very visible to eye.
    3) internal shoulder rotation. Not visible to eye or in standard video, requires high speed video to observe.

    I believe that players are using all three definitions in discussions. Its essential to look up the proper definition.

    High speed video of internal shoulder rotation -

    https://vimeo.com/27528701

    (The best way to do stop action on Vimeo or YT is to press the play-pause button as fast as possible.)

    Look at the elbow carefully, its turning indicates ISR. That motion from start to finish takes about 7 frames at 240 fps or 0.03 seconds. A standard 30fps video takes one frame every 0.033 second - you can get only one frame during the motion.

    When the upper arm turns from ISR, the racket - held at an angle to the axis of the arm - moves very fast. See the Toly discussions and illustrations showing the angle.

    Agree on your description of the external rotators not being deliberately contracted in the follow through.
     
    Last edited: May 2, 2012
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  24. tricky

    tricky Hall of Fame

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    "Pronation" is given an informal treatment whenever it's discussed on tennis forums. What is called pronation is that and other wrist/hand movements performed in conjunction.

    The wiping arc of the tennis racquet is a product of both pronation and radial deviation. The radial deviation prevents the wrist from flexing passively and rolling over the ball. It may also cause the elbow joint to trace an arc as well, though this is dependent on the sequencing between the internal shoulder rotation and abduction. And there's subtle differences here depending on WW technique.

    For the most part, the radial deviation is not actively managed by the person. The pronation is, but with the instruction that the wrist must be stable through contact. That is done so that the radial deviation and pronation will work in conjunction.

    Internal shoulder rotation is used through the complete swing, but it is used in conjunction with transverse adduction. The transverse adduction helps to create a swing arc that prevents the upper arm from coming around until the racquet has passed through the contact point. Transverse adduction, traditionally, was the primary component for creating depth and pace with the swing. It's still the most important shoulder component of the 1H BH.

    In that sense, the internal shoulder rotation provides the swing speed but does not directly create the shape of the forward swing or arm movement. Note: this is also true with throwing/pitching motions as well. In pitching circles, they use a concept called "scalpula loading" to denote the effect of internal shoulder rotation. The truth is, shoulder rotation is only meaningful when taught in conjunction with weight transfer. And again, in pitching circles, loading of the shoulder is usually taught with the technique of pushing off with feet.
     
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  25. toly

    toly Hall of Fame

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  26. sureshs

    sureshs Bionic Poster

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    SW grip with Nadalian topspin causes injuries. Unfortunately, it is a must in today's game.
     
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  27. Power Player

    Power Player G.O.A.T.

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    OP, dont worry about what your arm does..build everything else up..the windshield wiper and all that stuff comes from having good footwork, open stance, using your offhand to stretch across your body and initiate the swing.

    All these people post vids of their strokes, ask if they are windshield wiping..etc and it's all arm because thats all they focus on.
     
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  28. Chas Tennis

    Chas Tennis Hall of Fame

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    Bruce Elliott video referencing book.

    FYI - Bruce Elliott video referencing a biomechanics book on stroke technique.

    http://www.youtube.com/watch?v=_0qJjqzWaDA

    The book -

    Technique Development in Tennis Stroke Production, by Elliott & Reid

    This book is not easy to find in that Amazon, Barnes & Noble and Google list it as 'out of stock'.

    Found it in the ITF Store and ordered a copy.

    https://store.itftennis.com/category.asp?cid=12&lid=3&previousscript=/category.asp

    (I stopped giving information half way through the ordering process, registering, etc. and it accepted my order anyhow. Will let you know what I think of the book.)

    (Also, for anyone interested in this year's IFT special tennis issue from a big biomechanics conference in July, I understand that it will probably be available later this year.)
     
    Last edited: Jun 15, 2012
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